Low FT3 Low FT4 with T3/4 treatment, what is going on?

[CBDB]

I have been hovering in the background since lockdown, as my health has been going well, but have been reading and learning from this forum. I am always amazed by the support from community members, so huge warm thanks from me to everyone on here.

I recently have had my bloodtests done again, and I want to tweak my treatment a bit, as I am still getting regular tiredness spells and headaches. Not often, but they are annoying.

My newest stats are in the pic, and the strange thing is that even after a year of gluten free and dairy free nutrition, with all relevant supplements, I am still getting very high antibodies, and my FT3 and FT4 levels are still going down.

So I have a tweak in my mind but wanted to see if there is experience of my situation in the forum.

Some short details:

- I am Hashimotos, and am taking 100 microgram Levo and 20 microgram Liothyrine daily

- I supplement with selenium, omega 3, L-Glutamine, NAC, Viy C, iron, and B and D (Better You Spray), and also a systemic proteolytic enzymes.

- I am gluten and dairy free, and since 4 weeks am following an autoimmune diet

- Since 16 months or so, I have started running and then daily Yoga. Running is super slow Japanese jogging, which keeps heart rate down, and advice is to run at a speed where one can still have a conversation. This works for me. I run two 5ks per week and a longer ca 7-9k every weeks or so. So ca 15 - 20k per week. (Running has made me feel really great, so this is the biggest feel good factor for me. I definately want to keep that going, but I do wonder if that affects my FT3 and FT4 levels)

- Overall I feel really great, with once in a while getting day long headaches and also tiredness. I am very overweight, and have been very very slowly losing weight (4 kilos in 12 months), but it has been a slow slog, considering the dietary changes and exercise regimes I have started now more than a year ago. Since more than 10 years, I do not drink any alcohol, I never smoked, I do not eat sweets or chocolate. I do eat meat. My calorie intake is ca 1500 - 1700 per day, average.

My biggest issue is that I cannot seem to lose weight, and my lowering of FT3 and FT4 is - I believe the issue, knowing that FT3 has to be in the top third if I am to be able to lose weight.

My stats are in the pic with graphs but here below as well:

Four data points of: 09/07/2020 07/09/2020 07/06/2021 14/06/2021

TSH (2020+ ) Range: 0.27 - 4.2 :: 0.234 0.04 0.09 0.23

FT3 (2020+ ) Range: 3.1 - 6.8 :: 4.74 4.88 4

FT4 (2020+ ) Range: 12 - 22 :: 15.7 14.9 12.6 12.3

TPO-AB (2020+ ) Range: <34 :: 51.4 45.7 77.7 77.5

Tg-AB (2020+ ) Range: <115 :: 1051 880 733 731

Vitamins D and B are all ok, B12 on the high normal side.

My concerns:

1) One set of antibodies is coming down, the other one is going up. Not sure what is going on here, but both are way above the normal range. Too high.

2) Both FT4 and FT3 seem to be going down, I assume this is because my Thyroid is decreasing its ability to function. TSH is suppressed as I am medicating with both Lio and Levo. There does not seem to be a conversion issue from T4 to T3 as T4 is also low, as well as T3. It just seems there is not enough T4 and T3 in my body.

3) there is a worry that that I am reacting to old amalgam in my teeth. (thoughts?)

My ways forward:

1) I want to see if I can push my antibodies even further down by installing a water filter, filtering out Fluorides in the water. (thoughts? There are some low cost options )

2) I will also buy 100% organic from now on (I eat ca 30% organic, as it is so costly). This is going to be a tough one, due to costs. (Thoughts)

3) I will increase Levo by 50 micrograms in 25microgram steps.

4) I will increase Lio by 10 micrograms

Both lifting the intake of Levo and Lio should lift my FT3 and FT4 levels, as it seems to not be an issue with conversion.

Thoughts? Suggestions? So many thanks.

P.s. I test with medichecks, and as the one but last test was faulty (FT3 missing) I did it again only a week later.

[greygoose]

My concerns:

1. Antibodies fluctuate all the time, that's perfectly normal. Nothing to be concerned about - not much point in even retesting, actually.

2. As you have Hashi's, it's normal for your hormone levels to fluctuate, too. But, when you are taking both T4 and T3, it is impossible to know how well you convert. Your FT4 is low because you are taking T3, that's the way it works.

3. No thoughts on amalgam, sorry.

My ways forward:

1. Whilst installing a water filter is an excellant thing to do for all sorts of reasons, I seriously doubt if it will have any effect on your antibodies. And, even if you managed to get them down to zero - which is highly unlikely - you will still have Hashi's. It would make very little difference to the disease.

2. Pass

3/4. As I said above, taking T3 lowers the FT4. But, it's the FT3 the most important number. So, get that sorted first. Then, increase T4 is you feel the need. But, never, ever increase both at the same time. And, only increase T3 by 5 mcg every two weeks.

[CBDB in reply to greygoose]

That’s very clear. So many thanks!!!

So you would not think adding Levo (T4) helps to keep T3/T4 more stable as T4 has a much longer half-life, and Lio (T3) with its shorter half-life is more difficult to get to a sufficient and stable level?

Thanks again.

[greygoose in reply to CBDB]

I don't think that about T3 at all. It's short half-life does not detract from it's efficacity. You take a dose every day, so what does it matter about it's half life - which is 24 hours in the blood, by the way, and about three days in the cells.

I don't know how T4 would keep it 'more stable' unless you plan on missing a few days T3 - which I wouldn't recommend! lol

I take T3 only. T4 doesn't suit me at all. And I feel pretty stable all the time. I don't miss the T4. And I certainly didn't have any trouble finding a sufficient and stable level.

But, in any case, I wasn't suggesting you stop the levo altogether. Just get your FT3 to a decent level first, then think about T4. We all vary greatly in the amount of T4 we need with our T3. Me, it's none at all, as I said, but I know other people who need their FT4 up in the top quarter of the range. We all have to experiment to find out how much we need as an individual.

[CBDB in reply to greygoose]

Brill. This is really useful. So huge thanks.

Lio(T3) first, then. Got it! And yes, I wasn’t going to stop Levo. I feel pretty good so I’m lucky. I just need to watch those dropping FT4/FT3 levels and tweak it a bit to give me a chance to lose weight.

Again, big thanks

[greygoose in reply to CBDB]

You're very welcome.

[SlowDragon Administrator]

Your Ft3 looks too low

all thyroid blood tests should ideally be done as early as possible in morning and before eating or drinking anything other than water .

Last dose of Levothyroxine 24 hours prior to blood test. (taking delayed dose immediately after blood draw).

This gives highest TSH, lowest FT4 and most consistent results. (Patient to patient tip)

When on T3, day before test, split dose into three smaller doses roughly equal 8 hour intervals. Taking last dose T3 at roughly 8-12 hours before test

So on 20mcg per day

10mcg waking, 5mcg 2pm and 5mcg at 9pm ….assuming testing 9am

Is that how you do tests?

Suggest you increase T3 by 5mcg and retest in 6-8 weeks

Or you increase levothyroxine dose by 12.5mcg and retest in 6-8 weeks

Only increase levothyroxine or T3….not both at once

Do you normally take T3 as single dose or as 2 or 3 smaller doses

[CBDB in reply to SlowDragon]

Thanks so much. Yes, tests early ✔️, 24 hour last Levo dose ✔️.

I don’t split Lio(T3) usually. Take Lio(T3) on waking. So tests are almost a day after last dose of both Levo and Lio

Suggestion to Increase Lio(T3) by 5mcg. ✔️👍🏽Got it. Yes, I’ll do that before considering to increase Levo(t4). Thank you!

I think a way forward is becoming clearer. (=T3 increase for now).

Re- reading past posts, I do realise that according to my weight I should have 50micrograms more Levo (T4) than I do at present, with formula 1.6 times weight. But will increase t3 first.

Thank you so much!

[SlowDragon Administrator in reply to CBDB]

So Ft3 result is false low result

Last dose T3 should be maximum of 12 hours before test

Suggest you increase levothyroxine first

Then retest thyroid 6-8 weeks time making sure you leave correct time gaps

[CBDB in reply to SlowDragon]

Ok. Right. Interesting. So you’re thinking T3 might be ok, but T4 definitely low? (Which would mean my thyroid is still converting from T4 to T3, at least a bit?)

[SlowDragon Administrator in reply to CBDB]

It might just be you could be taking high enough dose T3

But Ft4 is definitely too low, so increasing levothyroxine will improve low Ft4 and may increase Ft3 too

Many on T3 find it better to split T3 every day. Trial and error what suits each person

[CBDB in reply to SlowDragon]

Thank you. Might need to think about this, as T3 is going down over the past years, and I always have tested like this. Hm 🤔.

Big thanks. This really helps.

[SlowDragon Administrator in reply to CBDB]

So you may need to increase T3 after next test …but increasing levothyroxine may stop Ft3 dropping too

[CBDB in reply to SlowDragon]

Yeah... there is that. Thank you. I think you are right, I’ll try Levo increase first. I should be on higher amounts anyway, considering weight.... now to convince my GP....

Many thanks, all of the feedback really helps to sort out all options, and interpreting what the stats mean. So hugely appreciated.